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AUTHOR REPLY

      The commenter raises several potential limitations of the study that we feel require clarification. First, we share the concern regarding the association between financial incentives and patient care decisions. This association was demonstrated previously.
      • Hollenbeck BK
      • Kaufman SR
      • Yan P
      • et al.
      Urologist practice affiliation and intensity-modulated radiation therapy for prostate cancer in the elderly.
      Second, this study included all Medicare beneficiaries who were newly diagnosed with prostate cancer and not limited to those treated by a urologist. As such, this provides a reasonable approximation of the population of men with newly diagnosed prostate cancer, as most such men are Medicare beneficiaries. Finally, while this data does not consider grade and stage, there is no compelling reason to suspect that these factors will systematically vary among practice types. Indeed, that intuition was confirmed in Hollenbeck et al using SEER-Medicare data with cancer stage and grade data.
      • Hollenbeck BK
      • Kaufman SR
      • Yan P
      • et al.
      Urologist practice affiliation and intensity-modulated radiation therapy for prostate cancer in the elderly.
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      Reference

        • Hollenbeck BK
        • Kaufman SR
        • Yan P
        • et al.
        Urologist practice affiliation and intensity-modulated radiation therapy for prostate cancer in the elderly.
        Eur Urol. 2018; 73: 491-498https://doi.org/10.1016/j.eururo.2017.08.001